Does mental illness exist?

further problem is that the so-called ‘symptoms’ are not examples of bodily dysfunction, such as pain, rashes and so on, but consist of a ragbag of social judgements about people’s thoughts, feelings and behaviour. For example, someone – usually a woman – diagnosed with ‘borderline personality disorder’ has been assessed as displaying ‘inappropriate, intense anger’ and ‘a pattern of unstable personal relationships.’ But we know that women who are so labelled very often have a history of abuse, which may make their so-called ‘symptoms’ entirely understandable.

Similarly, there is growing evidence that the hostile voices said to be a symptom of ‘schizophrenia’ may reflect earlier unprocessed traumas, such as bullying or domestic violence. And at the less severe end of the spectrum, the desperation and hopelessness that might be diagnosed as ‘depression’ is known to occur more often in personal and social contexts that give people very good reasons to be miserable.  These histories are routinely obscured and unaddressed within a system that re-interprets them as evidence of medical illness or disorder.

In essence, then, a diagnosis turns ‘people with problems’ into ‘patients with illnesses’. Reactions to receiving a diagnosis vary, and some people say that it offered welcome relief from guilt and isolation. For others, though, it constitutes the first step in a lifelong career as psychiatric patient, with everything that is implied – long-term use of psychiatric drugs, stigma, and social exclusion. Some have vividly described the profound disjunction in their sense of identity as this new version of reality is imposed on them:  ‘I walked into (the psychiatrist’s office) as Don and walked out a schizophrenic … I remember feeling afraid, demoralised, evil.’

Psychiatric diagnosis turns ‘people with problems’ into ‘patients with illnesses’.

How, then, do we proceed, if we want to accept the reality of people’s distress and yet dispute the validity of the medical explanations that are offered? This model has taken hold so strongly that it can seem bizarre to question it. And yet we have a mountain of research to confirm that all kinds of social and relationship adversities massively increase the likelihood of experiencing all varieties of mental distress. This includes poverty, unemployment, emotional neglect, physical and sexual abuse, domestic violence, bullying, and so on, as well as more subtle difficulties such as feeling criticised, undermined, invalidated and excluded.

At a wider level it has been demonstrated beyond dispute that we all suffer from living in societies that are unjust and economically unequal – ‘If Britain became as equal as the four most equal societies […] mental illness might be more than halved’ (Wilkinson & Pickett). Similarly, psychologists have described how whole societies may be affected by so-called ‘austerity ailments’ of humiliation and shame; fear and distrust; instability and insecurity; isolation and loneliness; and feeling trapped and powerless.

This perspective does not give us the neat explanations or the hope of simple cures that are offered by a diagnosis and a corresponding pill. It implies that we need very different solutions, at every level from individual to societal. One possible starting point is the core skill of all clinical psychologists, known as ‘formulation’ (Johnstone & Dallos). This is the process of making sense of a person’s difficulties in 

One thought on “Does mental illness exist?

  1. There remains platitudinous lip-service by society in genera, including police services, when it comes to proactive mental illness prevention as well as treatment.

    Various mainstream news and social media will state the obvious, that society must open up its collective minds and common dialogue when it comes to far more progressively addressing the challenge of more fruitfully treating and preventing such illness in general.

    But they will typically fail to address the problem of ill men, or even boys, refusing to open up and/or ask for help due to their fear of being perceived by peers, etcetera, as weak/non-masculine. The social ramifications exist all around us; indeed, it is endured, however silently, by males of/with whom we are aware/familiar or to whom so many of us are closely related.

    Even today, there remains a mentality, albeit perhaps a subconscious one: Men can take care of themselves, and boys often are basically little men. It could be the same mentality that might help explain why the book Childhood Disrupted was only able to include one man among its six interviewed adult subjects, there presumably being such a small pool of ACE-traumatized men willing to formally tell his own story of childhood abuse.

    And yet more evidence of a continuing subtle societal take-it-like-a-man mindset, one in which so many men will choose to abstain from ‘complaining’ about their torturous youth, as that is what ‘real men’ do.

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